According to a report shared by the National Institute of Mental Health, around one in five U.S. adults live with mental illness. Seniors are at a higher risk for mental health conditions, such as depression or anxiety, particularly when their health deteriorates and they face difficulty managing numerous diseases.
So if you’re having persistent feelings of despair or hopelessness, get in touch with a doctor immediately to talk about receiving the treatment you need.
If you are a Medicare recipient, you might be wondering if your plan covers mental health treatment and services. You will be happy to know that outpatient, inpatient, and partial hospitalization services are all covered under Medicare mental health coverage.
The post below covers everything you need to know about Medicare mental health coverage, including what type of Medicare plans are best for mental health conditions, different mental health services covered by your Medicare plan, and when to seek help for a mental health condition.
Mental Health Services Covered by Different Medicare Parts
Medicare Parts A and B cover the majority of mental health services. Let’s take a look at what each part entails.
1. Medicare Part A (Inpatient Hospitalization)
Medicare Part A includes mental health services associated with inpatient hospitalization. Individuals who go through acute mental health crises that pose a threat to themselves or others require this type of treatment.
The cost of the room is covered under Medicare Part A. Other than that, Part A also includes the following services:
- Inpatient therapy
- Standard nursing care
- Some medications and lab testing
2. Medicare Part B (Partial Hospitalization)
Medicare Part B includes mental health services associated with outpatient treatment, such as yearly depression screenings and The-Value-of-Structured-Outpatient-Treatment. Anyone who needs continuous mental health support should seek this type of treatment. Here are some other mental health services offered by Medicare Part B:
- Psychiatry appointments
- Some medications
- Diagnostic lab testing
- Specialized and general counseling appointments
- Clinical social worker appointments
- Substance use disorder treatment
- Partial hospitalization, also known as intensive outpatient care.
Additionally, Medicare Part B incorporates one yearly depression screening, referrals to other mental health professionals, and additional coverage for follow-up consultations.
3. Other Medicare Parts
Even though Medicare Parts A and B cover the majority of your mental health requirements, you can obtain extra coverage by enrolling in any one of the following Medicare plans:
- Medigap: It assists you with covering a certain amount of outpatient or inpatient care fees, such as deductibles and coinsurance.
- Medicare Part C: It helps cover all Medicare Parts A and B services, as well as prescription medications and additional coverage areas.
- Medicare Part D: Anti-anxiety medications, antidepressants, mood stabilizers, antipsychotics, and other mental health prescriptions are covered under Medicare Part D.
Does Medicare coverage include outpatient mental health services?
Partial hospitalization, outpatient mental health treatment, and yearly depression screenings are only covered if you are a beneficiary of Medicare Part B.
Medicare covers the majority of your outpatient treatment services, but you must fulfill some financial conditions before Medicare provides coverage. Here are a few basic Medicare Part B costs:
- Standard premium amount – $148.50
- Deductible – $203
- Any coinsurance or copayment fees if you use services at a hospital outpatient clinic
- 20% of the Medicare-approved amount when receiving a treatment.
For outpatient mental health counseling, there is no limit on the number of sessions or the frequency offered by Medicare. However, given that most treatments involve out-of-pocket expenses, you will need to assess your financial position to determine how frequently you can get treatment.
If you want to start counseling or therapy sessions under your Medicare plan, here are a few types of mental health care professionals approved by Medicare that you can visit:
- Physician assistant or nurse practitioner
- Social worker, clinical psychologist, or nurse specialist.
- Doctor or psychiatrist
If you still have no idea about whom to see, consult your doctor and ask about who can be the best specialist for you.
Does Medicare coverage include inpatient mental health services?
In order to be covered for inpatient mental health services at a psychiatric or general hospital, you must attain Medicare Part A. Medicare will cover the majority of your inpatient treatment services. However, depending on the stay length and the type of plan, you may still have to pay for some out-of-pocket expenses. Here are some basic Medicare Part A expenses:
- $1,484 deductible
- $259 – $471 premium, if you have one
- $742 coinsurance per day for 91+ of treatment, through your lifetime reserve days
- Daily coinsurance for lifetime reserve days – $742
- Coinsurance per day when a person has been an inpatient for 61–90 days – $371
- Coinsurance for 1 to 60 days of treatment – $0
- 20% of all Medicare-approved amounts during the treatment
- Beyond lifetime reserve days, you will pay 100% of treatment costs.
It is crucial to keep in mind that even though there is no limit to the amount of inpatient care you may receive in a general hospital, Medicare Part A will only cover inpatient care in a psychiatric facility for up to 190 days.
We grow more sensitive to health issues as we age, putting older individuals at a higher risk of mental health conditions, such as depression. Here are some common depression symptoms you will see in people over 65 years of age:
- Sleep changes
- Frequent mood changes
- Memory or concentration issues
- Appetite changes
- Losing enjoyment when participating in activities or hobbies
- Thoughts of harming oneself or others
- Constantly feeling negative emotions
- Other symptoms such as digestive issues, headaches, fatigue, etc.
If you are experiencing any of the symptoms listed above, talk to your doctor about what you should do next. Your doctor may refer you to a mental health expert who will further give you a diagnosis, speak to you about your symptoms, and get your treatment started.
Whether you are a beneficiary of Medicare Advantage or Original Medicare, you will be covered for both outpatient and inpatient mental health services. This also incorporates therapy visits, hospital stays, annual depression screenings, intensive outpatient care, and more.
As there are some costs associated with these mental health services, it is critical to pick the right Medicare plan suitable for all your requirements.
About the Author: Lynette Chen is a blogger and Medicare Advantage provider at Clever Care. She provides health coverage to individuals, paying for typical expenses such as doctor visits, hospital visits, dental care and nursing services. Visit to find out the most affordable Medicare Advantage plan covers.
In 2008 the United States government designated July as Bebe Moore Campbell National Minority Mental Health Awareness Month “to enhance public awareness of mental illness …. among minorities.”
Bebe Moore Campbell was an American author and mental health advocate who wrote works of fiction, nonfiction, and children’s literature about the harmful effects of racism and the mental health impacts on those affected.
Each July, www.rtor.org and its sponsor Laurel House, Inc. honor the legacy of Bebe Moore Campbell. We believe in using language that puts people first and emphasizes their individuality and unique contributions rather than their health or demographic status. Just as we do not refer to people living with schizophrenia as “schizophrenics,” we avoid terms such as “minority” and “marginalized” when referring to BIPOC (Black, Indigenous, and People of Color) and BIPOC Mental Health Month.
Please join us in recognizing the unique struggles BIPOC face and bringing awareness to the need for adequate, accessible, culturally relevant mental health treatment, care, and services.
Our recent blog post, 8 Accessible Mental Health Resources for Black, Indigenous, and People of Color (BIPOC), contains several links to online resources promoting the emotional wellbeing and access to mental health care for these communities.
www.rtor.org and Laurel House are committed to the advancement of racial equity and social justice and to making mental health services available to all.
Photo by J. Kelly Brito on Unsplash
The opinions and views expressed in any guest blog post do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in the article or linked to therein. Guest Authors may have affiliations to products mentioned or linked to in their author bios.
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